Crit Care Resusc
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Randomized Controlled Trial
Protocol for a multicentre randomised controlled trial of early and sustained prophylactic hypothermia in the management of traumatic brain injury.
Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Prophylactic hypothermia is effective in laboratory models, but clinical studies to date have been inconclusive, partly because of methodological limitations. Our Prophylactic Hypothermia Trial to Lessen Traumatic Brain Injury (POLAR) randomised controlled trial is currently underway comparing early, sustained hypothermia versus standard care in patients with severe TBI. We describe our study protocol and the challenges in conducting prophylactic hypothermia research in TBI. ⋯ After a run-in phase, recruitment for our main study began in December 2010. When the study is completed, we aim to provide evidence on the efficacy of prophylactic hypothermia in TBI to guide clinicians in their management of this devastating condition.
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Observational Study
Hospital outcomes associated with introduction of a two-tiered response to the deteriorating patient.
Liverpool Hospital introduced the medical emergency team system in 1990 and it has recently been adopted at a national and international level. New South Wales, Australia, has introduced a standardised rapid response system in over 250 acutecare hospitals: the two-tiered (clinical review call [CRC] and rapid response call [RRC]) "between the flags" (BTF) program. ⋯ After introduction of the BTF program, there was a progressive increase in documented CRCs and an increase in RRCs. There was no decrease in cardiac arrests or hospital deaths. RRCs based on objective physiological criteria increased. More research is needed to evaluate two-tiered response systems.
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Comparative Study
Agreement between radial and femoral arterial blood pressure measurements during orthotopic liver transplantation.
To study agreement between radial and femoral arterial pressure measurements in orthotopic liver transplantation (OLTx) surgery to determine whether arterial cannulation sites are interchangeable. ⋯ Radial artery SAP underestimates femoral artery measurements significantly but unpredictably. As femoral measurement is more likely to reflect central arterial pressure, radial SAP measurement is not reliable in adults undergoing OLTx.